Stage 4: Patient Expresses Maladaptive Pattern

Once the therapist diagnoses the patient's maladaptive relational pattern, the therapist helps the patient become aware of it. Because it is ingrained in the patient's personality (ego-syntonic), it is out of his or her awareness. So, the therapist needs to help the patient focus on the relationship and explicitly state what he or she wants from it. The relational diagnosis arrived at by the therapist in the Stage 3 provides a reference point from which to determine the degree of insight the patient has when asked what he or she wants from the therapist, and how he or she is trying to get it.

Even though the therapeutic relationship may have been in progress for 2 or 3 months, many patients will still be unable to verbalize what it is they want and the methods of manipulation they are using to get it. The therapist, however, does know because he or she has been present to the patient as the intended target of the maladaptive relational pattern. The therapist helps the patient discover the maladaptive relational pattern without directly interpreting it for the patient. The therapist constantly redirects the patient to explore the nature of the therapeutic relationship. This helps the patient discovery the maladaptive relational pattern. Once the patient possesses enough trust and insight, he or she will recognize and verbalize the maladaptive relational pattern. It is at this point the most intense period of treatment begins.



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